Healthcare Provider Details

I. General information

NPI: 1417385824
Provider Name (Legal Business Name): CLAIRE ELENA BYRNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE ELENA STANECKI

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 SEA LARK LN
NAVARRE FL
32566-7406
US

IV. Provider business mailing address

1762 SEA LARK LN
NAVARRE FL
32566-7406
US

V. Phone/Fax

Practice location:
  • Phone: 850-204-8030
  • Fax: 850-204-8031
Mailing address:
  • Phone: 850-204-8030
  • Fax: 850-204-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA13924
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202007208
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number110865
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: